Grief and the DSM5

Welcome to Sarah’s Corner, a place for everyone to learn and grow together.

As promised, my first weblog will explore what has happened to grief in the 5th revision of the “Diagnostic and Statistical Manual of Psychiatric Disorders” (DSM) and more important, how will this influence people experiencing grief?

A Brief History: The DSM is the manual of the American Psychiatric Association that describes the standards and criteria for defining and diagnosing mental illness. Since it was introduces some three decades ago, it has been used as a guide by psychiatrists, primary care physicians and others who treat psychiatric illnesses, conditions or disorders. Today, most insurances companies require a DSM code for reimbursement. The newly published 5th revision (DSM5), released early this summer, is the latest iteration of the manual.

The publication followed much controversy about many  of the changes, having to do with what is increasingly called the “medicalization” of life experiences. It seems that over time and imperceptibly, we have given physicians the moral authority to decide when the vicissitudes of life may be declared abnormal and labeled within the language of sickness, i.e. a syndrome/disorder to be “treated”.  Perhaps this over-arching reach by Medicine is best illustrated in the title of a new book by Dr. Allen Francis: “Saving Normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life”. The title says it all…by an “insider”.

Testament to this encroaching medical model as the predominant model to describe and “diagnose” all things human, is the change involving the grief experience. My specific focus today concerns that very controversial change. Many professionals who work with bereaved persons actively engaged this controversy while changes were under consideration…..to no avail! So, grief–that most human of human experiences–has effectively become a “mental disorder”: Major Depressive Disorder. It falls soundly into the waiting arms of the drug companies.

The change that is most disturbing has to do with what was called “the bereavement exclusion” in prior iterations of the DSM. This exclusion meant that if you a had experienced a loss within a year, you did not “fit the criteria” for Major Depressive Disorder. That exclusion has been removed and you could be diagnosed with Major Depressive Disorder as early as two weeks following a loss…and certainly be ordered antidepressants.

Here is some of what Dr. Allen Francis–whose new book I just mentioned–said about the change: (he is the psychiatrist who chaired the 4th revision of the DSM, which included the bereavement exclusion): “After 40 years and lots of clinical experience, I can’t distinguish at two weeks between normal grief and mild depression….this is an inherently unreliable distinction….and I know damn well that primary care doctors can’t do it in a 7-minute visit….they prescribe 80% of all antidepressants and will be most likely to misuse the DSM-5 in mislabeling grievers”.

They did not listen…not even to the plea of an “insider”.

As I reflect on what has happened to this most human of human experiences, I invite your thought and reflections, questions or comments as you read this first blog:

  • Shall we trade the ancient wisdom of the solidarity of connection that heals the pain of loss for a “disorder” to be “treated”?
  • Are we willing to label the precious memories that sustain us through our grieving “a psychotic feature”?
  • Will we forego the opportunity to grow through our suffering to the joy of different ways to be happy?
  • Are we willing to give grief to Big Pharma?

These are some of my questions and reflections…please share some of yours with me.

My next weblog will return us to griefadifferentway. I will discuss what I mean when I say that grief is a “gift”…..many an eyebrow is raised when I say that, so we will explore it next time; meanwhile, grief as Major Depressive Disorder within two weeks after a loss??

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